Benzoic acid, benzoic acid derivatives and heteroaryl carboxylic acid conjugates of hydromorphone, prodrugs, methods of making and use thereof

ABSTRACT

The presently described technology provides compositions comprising aryl carboxylic acids chemically conjugated to hydromorphone (4,5-α-epoxy-3-hydroxy-17-methyl morphinan-6-one) to form novel prodrugs/compositions of hydromorphone. The hydromorphone prodrugs of the present technology have decreased side effects and decreased potential for abuse compared to unconjugated hydromorphone. The present technology also provides methods of treating patients, pharmaceutical kits and methods of synthesizing conjugates of the present technology.

RELATED APPLICATIONS

This application is a divisional application of U.S. application Ser.No. 14/336,549, filed on Jul. 21, 2014, entitled “Benzoic Acid, BenzoicAcid Derivatives and Heteroaryl Carboxylic Acid Conjugates ofHydromorphone, Prodrugs, Methods of Making and Use Thereof,” which is acontinuation application of U.S. application Ser. No. 13/660,112, filedon Oct. 25, 2012, entitled “Benzoic Acid, Benzoic Acid Derivatives andHeteroaryl Carboxylic Acid Conjugates of Hydromorphone, Prodrugs,Methods of Making and Use Thereof,” which claims priority to and benefitof U.S. Provisional Application No. 61/657,201, filed on Jul. 8, 2012,entitled “Benzoic Acid, Benzoic Acid Derivatives and HeteroarylCarboxylic Acid Conjugates of Hydromorphone, Prodrugs, Methods of Makingand Use Thereof,” and U.S. Provisional Application No. 61/551,600, filedon Oct. 26, 2011, entitled “Benzoic Acid, Benzoic Acid Derivatives andHeteroaryl Carboxylic Acid Conjugates of Hydromorphone, Prodrugs,Methods of Making and Use Thereof,” the disclosures of which are herebyincorporated by reference in their entireties.

FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

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MICROFICHE/COPYRIGHT REFERENCE

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BACKGROUND OF THE INVENTION

Opioids are highly effective as analgesics and are commonly prescribedfor the treatment of acute and chronic pain. They are also commonly usedas antitussives. The opioids, however, also produce euphoria and/or“drug liking effects” and are highly addictive. As a result they areoften abused with far reaching social and health related consequences.

Because of the inherent potential for abuse, it is desirable that anypharmaceutical composition containing an opioid agonist be made asabuse-resistant or abuse-deterrent as practical. Illicit users oftenwill attempt to insufflate, inject or otherwise misuse the product inorder to achieve a more efficient or immediate effect from the opioidagonist.

Despite their addictive properties and the potential for abuse,morphine-like drugs, particularly, codeine, hydrocodone, hydromorphoneand oxycodone have been routinely prescribed as treatment for severe,acute and chronic pain for decades. This is, in part, because there arecurrently no better alternatives to relieve severe pain that isresistant to other less potent analgesics such as non-steroidalanti-inflammatory drugs (NSAIDS). In this regard, there is a need todecrease the abuse potential of opioid analgesics. Thus far, approachestaken, unfortunately, have not solved the problem.

Hydromorphone (4,5-α-epoxy-3-hydroxy-17-methyl morphinan-6-one) is ahydrogenated ketone of morphine that is used as a centrally actingopioid analgesic and antitussive. Hydromorphone is a semisyntheticnarcotic analgesic prepared from morphine that possesses multipleactions qualitatively similar to those of morphine and is used inmedicine as an alternative to morphine. It is mainly used for relief ofpain and as a narcotic antitussive for cases of dry, painful coughing.Hydromorphone interacts predominantly with the opioid receptors in thecentral nervous system (CNS). Its analgesic properties are primarily dueto agonist activity at the μ-opioid receptor. Hydromorphone is also apartial agonist of the δ-opioid receptor and an agonist of the κ-opioidreceptor. Additionally, hydromorphone exhibits antitussive properties bysuppressing the cough reflex in the medullary cough center of the brain.

Patients taking opioid analgesics such as hydromorphone for pain and/orcough relief can become unintentionally addicted. As tolerance to theopioids develops, higher amounts of the drug are needed to alleviate thesymptoms and generate the sense of wellbeing initially achieved with theprescribed dose. This leads to dose escalation, which, if leftunchecked, can lead rapidly to addiction. In some cases patients havebecome addicted in as little as thirty days.

Opioid induced constipation (OIC) is a common side effect of paintreatment with opioids. It affects approximately 40-90% of the patientswho are chronically taking opioid medication. Additionally, patientssuffering from OIC may become resistant to laxative treatments. Althoughthe mechanism is not yet fully understood, it is assumed that thebinding of agonists to the peripheral μ-opioid receptors in thegastrointestinal (GI) tract is the primary cause of OIC. This opioidreceptor activation impairs the coordination of the GI function by theenteric nervous system (ENS) resulting in decreased gut motility bydelaying the transit time of fecal content through interference with thenormal tone and contractility of the bowels. While the contractions ofthe circular muscles are increased causing non-propulsive kneading andchurning (stasis) and increased fluid absorption, the longitudinalsmooth muscle tone is decreased causing reduced forward peristalsis andadditional time for desiccating fecal matter. Furthermore, the analsphincter tone is increased making defecation more difficult. Theclinical presentation of these effects typically manifests itself insymptoms of hard/dry stool, straining, incomplete evacuation, bloatingand abdominal distention.

BRIEF SUMMARY OF THE INVENTION

The present technology utilizes conjugation of the opioid hydromorphonewith certain aryl carboxylic acids to decrease its potential for causingoverdose or abuse by requiring the active hydromorphone to be releasedthrough enzymatic or metabolic breakdown of the conjugate in vivo. Thepresent technology also provides methods of delivering hydromorphone asconjugates that release the hydromorphone following oral administrationwhile being resistant to abuse by circuitous routes such as intravenous(“shooting”) injection and intranasal administration (“snorting”).

Advantages of certain embodiments of the hydromorphone prodrugs of thepresent technology include, but are not limited to, reduced drug abusepotential, reduced or eliminated opioid induced constipation (OIC),reduced risk of chemical or physical manipulation resulting in fulldosage of hydromorphone release, reduced patient to patient variabilityin plasma concentrations compared to free hydromorphone, improved dosageforms through modifications of the physical and chemical properties ofthe prodrugs and improved side effect profile through reduced conversionof the hydromorphone prodrug to undesirable hydromorphone-3-glucuronide.

In some aspects, the present technology provides an immediate releasecomposition of conjugated hydromorphone that allows delivery of thehydromorphone into the blood system of a human or animal in atherapeutically bioequivalent manner upon oral administration. In atleast one aspect, the compositions/formulations of the currenttechnology can lessen common side effects associated with unconjugatedhydromorphone and similar compounds. The presently described technology,in at least one aspect, provides a slow/sustained/controlled releasecomposition of conjugated hydromorphone that allowsslow/sustained/controlled delivery of the hydromorphone into the bloodsystem of a human or animal within a safe therapeutic window upon, forexample, oral administration. At least some compositions/formulations ofthe current technology can lessen addiction/abuse potential associatedwith unconjugated hydromorphone and similar compounds.

In additional aspects, the present technology utilizes conjugation ofnatural non-toxic ligands to hydromorphone to create a new class ofprodrugs. The prodrugs of the present technology can be easilyrecognized by the metabolic systems and hydrolyzed to release the activeopioid in a controlled fashion upon oral administration. Other routes ofadministration render the compounds of the present technologyineffective or less effective, thereby preventing or decreasing drugabuse. Additional methods of drug abuse are also averted due to thephysical tampering resistance and prevention or reduction of euphoriaupon ingestion of high doses of the prodrugs of the present technology.Depending on the choice of ligand, pharmacokinetic (PK) profiles ofhydromorphone liberated from the prodrugs of the present technology canbe modulated to optimize blood levels versus time for a specificindication and to improve its safety profile. Additionally, by selectingappropriate ligands, the prodrugs of the present technology can deliverhydromorphone into the systemic circulation without interacting with theopioid receptors in the enteric nervous system thus reducing orpreventing opioid induced constipation (OIC).

In another aspect, the present technology provides aryl carboxylic acidschemically attached to hydromorphone to create prodrugs that can releasethe active opioid. The prodrugs of the present technology do not exhibitsignificant analgesic activity and by choosing suitable ligandssignificantly reduce the amounts of hydromorphone released into thesystemic circulation when administered intranasally or intravenously.Moreover, the narcotic cannot be “extracted” from the prodrugs of thepresent technology by simple physical tampering due to the nature of thecovalent enol ester and/or phenol ester bond between hydromorphone andthe aryl carboxylic acid. This class of compounds, of the presenttechnology, may be viewed as less attractive to potential drug abusersthan traditionally formulated drugs and may provide an improved safetyprofile and reduced side effects.

Additionally, by choosing appropriate ligands, all or most of theinactive prodrugs of the present technology can survive the transitthrough the gastrointestinal (GI) tract until they are absorbed, thuspreventing hydromorphone from interacting with the opioid receptors inthe enteric nervous system. This lack of binding to the peripheralopioid receptors can significantly reduce or even prevent opioid inducedconstipation.

In at least one aspect, the present technology provides at least oneprodrug composition comprising at least one conjugate, the conjugatecomprising at least one hydromorphone, and at least one aryl carboxylicacid.

In another aspect, the present technology provides at least onehydromorphone prodrug comprising an aryl carboxylic acid chemicallybonded to hydromorphone by reacting the carboxylic acid moiety of thearyl carboxylic acid with the C-6 enol tautomer of hydromorphone.

In another aspect, the present technology provides at least one prodrugcomprising the at least one hydromorphone chemically bonded to the atleast one aryl carboxylic acid by reacting the carboxylic acid moiety ofthe aryl carboxylic acid with the C-3 hydroxyl of hydromorphone.

In another aspect, the present technology provides a prodrug comprisingat least one hydromorphone chemically bonded to at least one arylcarboxylic acid by reacting the carboxylic acid moiety of one arylcarboxylic acid with the C-6 enol tautomer of hydromorphone and reactingat least one aryl carboxylic acid with the C-3 hydroxyl ofhydromorphone.

In other aspects, the present technology provides at least one prodrugwith at least one aryl carboxylic acid comprising a carboxylic groupattached directly to at least one aryl moiety.

In another aspect, the present technology provides at least one prodrugwith at least one hydromorphone chemically attached to at least onebenzoate of the general formula I:

where R¹, R² and R³ are independently selected from the group consistingof hydrogen, hydroxyl, amino, amine, amide, thiol, cyano, nitro,halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl,alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl,cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy,sulfonyl, phosphonate.

In at least one aspect, the present technology provides a hydromorphoneprodrug with at least one aryl carboxylic acid comprising a carboxylicgroup that is connected by a one-carbon linker to the aryl moiety.

In another aspect, the present technology provides at least onehydromorphone prodrug chemically attached to at least one phenylacetateof the following general formula II:

where R¹, R², R³ and R⁴ are independently selected from the groupconsisting of hydrogen, hydroxyl, amino, amine, amide, thiol, cyano,nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl,alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl,cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy,sulfonyl, phosphonate.

In other aspects, the present technology provides hydromorphone prodrugscontaining at least one aryl carboxylic acid comprising a carboxylicgroup that is connected by a two-carbon linker to the aryl moiety.

In additional aspects, the present technology provides hydromorphoneprodrug compositions comprising benzylacetates and cinnamates having thefollowing general formula III or IV or combinations thereof:

where R¹, R², R³ and R⁴ are independently selected from the groupconsisting of hydrogen, hydroxyl, amino, amine, amide, thiol, cyano,nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl,alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl,cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy,sulfonyl, phosphonate.

In other aspects, the hydromorphone prodrugs of the present technologyinclude at least one aryl carboxylic acid comprising a carboxylic groupattached to an aryl moiety ring by an alkyl chain.

In other aspects, the hydromorphone prodrugs of the present technologyinclude at least one aryl carboxylic acid comprising a carboxylic groupattached to an aryl moiety ring by an alkenyl chain.

In additional aspects, the hydromorphone prodrugs of the presenttechnology contain at least one aryl carboxylic acid that comprises acarbon chain between the aryl ring and the carboxyl group with one ormore side chains.

In additional aspects, the hydromorphone prodrugs of the presenttechnology contain at least one aryl carboxylic acid that comprises oneor more functional groups in addition to at least one carboxyl group.

In other aspects, the hydromorphone prodrugs of the present technologycontain at least one aryl carboxylic acid that comprises at least oneheteroaryl carboxylic acid.

In additional aspects, the present technology provides hydromorphoneprodrug compositions comprising heteroaryl carboxylic acid of thefollowing general formula V, VI, VII, VIII, IX, X, XI, XII, or XIII orcombinations thereof:

where R¹, R² and R³ are independently selected from the group consistingof hydrogen, hydroxyl, amino, amine, amide, thiol, cyano, nitro,halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl,alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl,cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy,sulfonyl, phosphonate.

In other aspects, the present technology provides at least onehydromorphone prodrug that contains an aryl carboxylic acid comprising asix-membered ring.

In other aspects, the present technology provides at least onehydromorphone prodrug that contains an aryl carboxylic acid comprisingonly one free carboxylic acid group.

In additional aspects, the present technology provides at least onehydromorphone prodrug that contains an aryl carboxylic acid comprisingbetween 1 to 4 phenyl substituents.

In certain aspects, the present technology provides at least onehydromorphone prodrug conjugate that is a neutral prodrug.

In certain aspects, the present technology provides at least onehydromorphone prodrug conjugate that is a free acid.

In certain aspects, the present technology provides at least onehydromorphone prodrug conjugate that is a free base.

In additional aspects, the present technology provides at least onehydromorphone prodrug conjugate that is a pharmaceutically acceptableanionic or cationic salt form or salt mixtures thereof.

In certain aspects, the hydromorphone prodrug compositions of thepresent technology are broken down in vivo releasing activehydromorphone and an aryl carboxylic acid or derivatives or metabolitesthereof.

In certain aspects, the hydromorphone prodrug compositions of thepresent technology are administered orally and hydrolyzed in vivoreleasing hydromorphone from the prodrug.

In other aspects, the hydromorphone prodrug compositions of the presenttechnology exhibit no or limited pharmacological activity uponadministration.

In other aspects, the hydromorphone prodrug compositions of the presenttechnology release hydromorphone in a manner that is similar to free orunmodified hydromorphone upon administration at equimolar dosages.

In additional aspects, the hydromorphone prodrug compositions of thepresent technology control and limit the release of hydromorphone intothe systemic circulation when the prodrug is administered via routesother than oral.

In certain aspects, the hydromorphone prodrug compositions of thepresent technology release hydromorphone in a controlled or sustainedmanner upon administration.

In other aspects, the hydromorphone prodrug compositions of the presenttechnology exhibit no or decreased side effects compared to unmodifiedhydromorphone upon administration at equimolar dosages.

In additional aspects, administration of the hydromorphone prodrugcompositions of the present technology results in hydromorphoneconcentrations in the plasma or blood that are significantly decreasedcompared to unmodified hydromorphone upon administration at equimolardosages by intravenous or intranasal routes.

In other aspects, administration of the hydromorphone prodrugcompositions of the present technology does not cause or results inreduced euphoria or drug liking effect compared to unmodifiedhydromorphone upon intranasal or intravenous administration at equimolardosages.

In some aspects, administration of the hydromorphone prodrugcompositions of the present technology does not result in a rapidhydromorphone concentration spike (C_(max)) in the blood or plasma uponoral administration.

In other aspects, administration of the hydromorphone prodrugcompositions of the present technology results in a delayed T_(max)compared to unmodified hydromorphone when administered orally atequimolar dosages.

In additional aspects, administration of the hydromorphone prodrugcompositions of the present technology results in a lower C_(max) valuecompared to unmodified hydromorphone when administered orally atequimolar dosages.

In further aspects, physical manipulation of the hydromorphone prodrugcompositions of the present technology does not result in the liberationof free hydromorphone.

In other aspects, the hydromorphone prodrug compositions of the presenttechnology exhibit resistance to certain chemical manipulations intendedto liberate free hydromorphone.

In other aspects, administration of the hydromorphone prodrugcompositions of the present technology does not cause or results ininsignificant activity at μ-opioid receptors.

In other aspects, the hydromorphone prodrug compositions of the presenttechnology are not or are limitedly subjected to enzymatic hydrolysisuntil absorbed in the gut.

In further aspects, the hydromorphone prodrug compositions of thepresent technology exhibit decreased conversion tohydromorphone-3-glucuronide (H3G) compared to unmodified hydromorphonewhen administered orally at equimolar dosages.

In other aspects, the hydromorphone prodrug compositions of the presenttechnology prevent or decrease opioid induced constipation (OIC)compared to unmodified hydromorphone when administered orally atequimolar dosages.

In other aspects, the hydromorphone prodrug compositions of the presenttechnology comprise additional active pharmaceutical ingredients (APIs),including, for example, ibuprofen, acetaminophen, or aspirin.

In certain aspects, the hydromorphone prodrug compositions of thepresent technology may be 3-aspirin-hydromorphone,3,6-di-aspirin-hydromorphone, 6-o-salicylate-hydromorphone,3-cinnamate-hydromorphone, 6-naproxen-hydromorphone,3-isoniacin-hydromorphone, 3-p-salicylic-hydromorphone,3-fenamate-hydromorphone, 3-benzoate-hydromorphone, and3,6-di-benzoate-hydromorphone.

In other aspects, the hydromorphone prodrug compositions of the presenttechnology are in an oral dosage form. In some aspects, the oral dosageforms of the present technology are solid dosage forms. In additionalaspects, the excipients of the present technology are antiadherents,binders, coatings, disintegrants, fillers, flavors, colors, glidants,lubricants, preservatives, sorbents and sweeteners.

In additional aspects, the hydromorphone prodrug compositions of thepresent technology are provided as tablets, capsules, softgel capsules,modified release capsules, extended release tablets, controlled releasecapsules, suppositories, powders for injection, oral liquids, coughsyrups, transdermal film, oral thin film, slurry or injections.

In certain aspects, the hydromorphone prodrug compositions of thepresent technology are provided at oral dosage strengths that areequimolar to from about 0.1 mg to about 200 mg of unmodifiedhydromorphone.

In other aspects, the present technology provides a method of treating apatient in need of an analgesic effect by administering an amount of atleast one hydromorphone prodrug composition of the present technologythat is therapeutically equivalent to an effective amount ofunconjugated hydromorphone.

In further aspects, the present technology provides a method ofsynthesizing the hydromorphone prodrug compositions of the presenttechnology.

In other aspects, the present technology provides a method of treating apatient in need of an analgesic effect by administering an amount of3-aspirin-hydromorphone, 3,6-di-aspirin-hydromorphone,6-salicylate-hydromorphone, 3-cinnamate-hydromorphone, or3-benzoate-hydromorphone that is therapeutically equivalent to aneffective amount of unconjugated hydromorphone.

In additional aspects, the present technology provides a pharmaceuticalkit containing a specified amount of individual doses containing anamount of at least one conjugate that is therapeutically equivalent toan effective amount of unconjugated hydromorphone wherein the at leastone conjugate comprises at least one hydromorphone and at least one arylcarboxylic acid.

BRIEF DESCRIPTION OF SEVERAL VIEWS OF THE DRAWINGS

FIGS. 1A and 1B. Example chemical structures of some hydroxybenzoatesfor use in the making of the hydromorphone prodrug compositions of thepresent technology.

FIG. 2. Example chemical structures of some aminobenzoates for use inthe making of the hydromorphone prodrug compositions of the presenttechnology.

FIG. 3. Example chemical structures of some aminohydroxybenzoates foruse in the making of the hydromorphone prodrug compositions of thepresent technology.

FIG. 4. Example chemical structures of some heteroaryl carboxylic acidsfor use in the making of the hydromorphone prodrug compositions of thepresent technology.

FIG. 5. Example chemical structures of some phenylacetates for use inthe making of the hydromorphone prodrug compositions of the presenttechnology.

FIG. 6. Example chemical structures of some benzylacetates for use inthe making of the hydromorphone prodrug compositions of the presenttechnology.

FIG. 7. Example chemical structures of some cinnamates for use in themaking of the hydromorphone prodrug compositions of the presenttechnology.

FIG. 8. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that were dosed orally with doses of 3-aspirin-HM,3,6-di-aspirin-HM and HM equimolar to 2.0 mg/kg of hydromorphone.

FIG. 9. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that were dosed orally with doses of 6-o-salicylate-HMand HM equimolar to 2.0 mg/kg of hydromorphone.

FIG. 10. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that were dosed orally with doses of 3-cinnamate-HM andHM equimolar to 2.0 mg/kg of hydromorphone.

FIG. 11. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that were dosed orally with doses of 6-naproxen-HM and HMequimolar to 2.0 mg/kg of hydromorphone.

FIG. 12. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that were dosed orally with doses of 3-isoniacin-HM andHM equimolar to 2.0 mg/kg of hydromorphone.

FIG. 13. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that were dosed orally with doses of 3-p-salicylate-HMand HM equimolar to 2.0 mg/kg of hydromorphone.

FIG. 14. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that were dosed orally with doses of 3-fenamate-HM and HMequimolar to 2.0 mg/kg of hydromorphone.

FIG. 15. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that were dosed orally with doses of 3-benzoate-HM,3,6-di-benzoate-HM and HM equimolar to 2.0 mg/kg of hydromorphone.

FIG. 16. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that was dosed intranasally with doses of3,6-di-aspirin-HM and HM equimolar to 2.0 mg/kg of hydromorphone.

FIG. 17. Pharmacokinetic profile of released hydromorphone (HM) in theplasma of rats that was dosed intravenously with doses of3,6-di-aspirin-HM and HM equimolar to 0.2 mg/kg of hydromorphone.

FIG. 18. Area under the curve (AUC) of released hydromorphone (HM) inthe plasma of rats that were dosed orally with escalating equimolardoses of HM and 3,6-di-aspirin-HM.

FIG. 19. Area under the curve (AUC) and peak plasma concentrations(C_(max)) in the plasma of rats that were dosed orally with equimolardoses of HM, untampered 3,6-di-aspirin-HM, and hydrolytic breakdownproducts of 3,6-di-aspirin-HM.

FIG. 20. Gastrointestinal (GI) transit distance from validated ratmotility study of rats dosed orally with equimolar doses of HM and3,6-di-aspirin-HM.

FIGS. 21A through 21D. Example synthetic schemes for the synthesis ofsome of the hydromorphone prodrugs of the present technology.

FIG. 22. Example synthetic scheme for the synthesis of some of thehydromorphone prodrugs of the present technology.

DETAILED DESCRIPTION OF THE INVENTION

Composition

The present technology provides compositions comprising aryl carboxylicacids that are chemically conjugated to hydromorphone(4,5-α-epoxy-3-hydroxy-17-methylmorphinan-6-one) to form novel prodrugsand compositions of hydromorphone. In some embodiments, the chemicalbond between these two moieties can be established by reacting thecarboxylic acid function of an aryl carboxylic acid with one of thefollowing functional groups of hydromorphone:

(a) C-6 enol tautomer of hydromorphone

(b) C-3 hydroxyl of hydromorphone,

(c) or both C-3 hydroxyl and C-6 enol tautomer hydromorphone.

The use of “opioid” is meant to include any drug that activates theopioid receptors found in the brain, spinal cord and gut. There are fourbroad classes of opioids: naturally occurring opium alkaloids, such asmorphine (the prototypical opioid) codeine, and thebaine; endogenousopioid peptides, such as endorphins; semi-synthetics such as heroine,oxycodone and hydrocodone that are produced by modifying natural opiumalkaloids (opiates) and have similar chemical structures; and puresynthetics such as fentanyl and methadone that are not produced fromopium and may have very different chemical structures than the opiumalkaloids. Additional examples of opioids are hydromorphone,oxymorphone, methadone, levorphanol, dihydrocodeine, meperidine,diphenoxylate, sufentanil, alfentanil, propoxyphene, pentazocine,nalbuphine, butorphanol, buprenorphine, meptazinol, dezocine, andpharmaceutically acceptable salts thereof.

The use of “therapeutically equivalent” is meant to describe drugproducts that are pharmaceutical equivalents and can be expected to havethe same clinical effect when administered to patients under theconditions specified in the label.

The use of “bioequivalent” is meant to describe pharmaceuticalequivalent or pharmaceutical alternative products that displaycomparable bioavailability (i.e., systemic plasma concentrations ofhydromorphone) when studied under similar experimental conditions.

The use of “hydromorphone” is meant to include a semisynthetic narcoticanalgesic that possesses multiple actions qualitatively similar to thoseof morphine and is used in medicine as an alternative to morphine. It ismainly used for relief of pain and as a narcotic antitussive for casesof dry, painful coughing. Trade names include Dilaudid®, Exalgo®,Hydrostat®, and Palladone® (extended release). Other pharmaceuticallyacceptable salt forms of hydromorphone are also encompassed by certainembodiments of the present technology. The chemical structure ofhydromorphone is:

Aryl carboxylic acids of the present technology can be grouped intovarious categories and subcategories. In certain embodiments, thecarboxyl group can be attached directly to the aromatic ring or beseparated by an alkyl or alkenyl chain. In other embodiments of thepresent technology, the chain length of the alkyl or alkenyl groupshould not exceed two unbranched carbons, but is not limited in numbersof atoms on potential side chains or additional functional groups.

In other embodiments, the present technology includes both carbon onlyaryl groups and aryl groups with heteroatoms (heteroaryl). The aryl orheteroaryl group of certain embodiments of the present technology, whichis connected directly or through an alkyl or alkenyl chain to thecarboxyl function, can be a 6-membered ring and contain no, one, or morethan one heteroatom. Additional substituted or unsubstituted aromatic oraliphatic rings may be fused to this 6-membered aryl or heteroarylmoiety in certain embodiments of the present technology.

In some embodiments of the present technology, the aryl carboxylic acidsmay have one or more free carboxylic acid groups and the total number ofphenyl substituents on the 6-membered ring can be four or less.

Depending on the individual aryl carboxylic acid that is connected tohydromorphone, the prodrug of the present technology can take on aneutral, free acid, free base, or various pharmaceutically acceptableanionic or cationic salt forms or salt mixtures with any ratio betweenpositive and negative components.

In certain embodiments, salt forms of the prodrugs of the presenttechnology include, but are not limited to: acetate, l-aspartate,besylate, bicarbonate, carbonate, d-camsylate, l-camsylate, citrate,edisylate, formate, fumarate, gluconate, hydrobromide/bromide,hydrochloride/chloride, d-lactate, l-lactate, d,l-lactate, d,l-malate,l-malate, d-malate, mesylate, pamoate, phosphate, succinate, sulfate,bisulfate, d-tartrate, l-tartrate, d,l-tartrate, meso-tartrate,benzoate, gluceptate, d-glucuronate, hybenzate, isethionate, malonate,methylsufate, 2-napsylate, nicotinate, nitrate, orotate, stearate,tosylate, thiocyanate, acefyllinate, aceturate, aminosalicylate,ascorbate, borate, butyrate, camphorate, camphocarbonate, decanoate,hexanoate, cholate, cypionate, dichloroacetate, edentate, ethyl sulfate,furate, fusidate, galactarate (mucate), galacturonate, gallate,gentisate, glutamate, glutarate, glycerophosphate, heptanoate(enanthate), hydroxybenzoate, hippurate, phenylpropionate, iodide,xinafoate, lactobionate, laurate, maleate, mandelate, methanesufonate,myristate, napadisilate, oleate, oxalate, palmitate, picrate, pivalate,propionate, pyrophosphate, salicylate, salicylsulfate, sulfosalicylate,tannate, terephthalate, thiosalicylate, tribrophenate, valerate,valproate, adipate, 4-acetamidobenzoate, camsylate, octanoate, estolate,esylate, glycolate, thiocyanate, undecylenate, sodium, potassium,calcium, magnesium, zinc, aluminum, lithium, cholinate, lysinium,ammonium, and tromethamine.

The prodrugs of certain embodiments of the present technology aredesigned to be broken down in vivo either enzymatically or otherwisethus releasing the active hydromorphone and the respective arylcarboxylic acid(s) or metabolites thereof. The aryl carboxylic acids ofthe present technology should be non-toxic at the given dosing levelsand are preferably known drugs, natural products, metabolites, or GRAS(Generally Recognized As Safe) compounds (e.g., preservatives, dyes,flavors, etc.) or non-toxic mimetics thereof.

In some embodiments, the aryl carboxylic acids of the present technologycomprise a carboxylic group that is attached directly to the arylmoiety. These aryl carboxylic acids can be divided into twosubcategories: benzoates and heteroaryl carboxylic acids.

Benzoates

Benzoates of certain embodiments of the present technology includeaminobenzoates (e.g., anthranilic acid analogs such as fenamates) andhydroxybenzoates (e.g., salicylic acid analogs). The general chemicalstructure of the benzoates of the present technology is represented bythe following general formula I:

where R¹, R² and R³ are independently selected from the group consistingof hydrogen, hydroxyl, amino, amine, amide, thiol, cyano, nitro,halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl,alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl,cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy,sulfonyl, phosphonate.

Benzoates are common in nature in the form of natural products andmetabolites. Numerous benzoic acid analogs are also used in the food anddrug industry. Some of the more abundant benzoates are derivatives withhydroxyl or amino groups or a combination of both. The hydroxyl andamino functions may be present in their free form or capped with anotherchemical moiety. In certain embodiments of the present technology theother chemical moiety is preferably, but not limited to, methyl oracetyl groups. In some embodiments of the present technology, the phenylring may have additional substituents.

Some examples of hydroxybenzoates of the present technology, include butare not limited to, benzoic acid, salicylic acid, acetylsalicylic acid(aspirin), 3-hydroxybenzoic acid, 4-hydroxybenzoic acid,6-methylsalicylic acid, o,m,p-cresotinic acid, anacardic acids,4,5-dimethylsalicylic acid, o,m,p-thymotic acid, diflusinal,o,m,p-anisic acid, 2,3-dihydroxybenzoic acid (2,3-DHB), α,β,γ-resorcylicacid, protocatechuic acid, gentisic acid, piperonylic acid,3-methoxysalicylic acid, 4-methoxysalicylic acid, 5-methoxysalicylicacid, 6-methoxysalicylic acid, 3-hydroxy-2-methoxybenzoic acid,4-hydroxy-2-methoxybenzoic acid, 5-hydroxy-2-methoxybenzoic acid,vanillic acid, isovanillic acid, 5-hydroxy-3-methoxybenzoic acid,2,3-dimethoxybenzoic acid, 2,4-dimethoxybenzoic acid,2,5-dimethoxybenzoic acid, 2,6-dimethoxybenzoic acid, veratric acid(3,4-dimethoxybenzoic acid), 3,5-dimethoxybenzoic acid, gallic acid,2,3,4-trihydroxybenzoic acid, 2,3,6-trihydroxybenzoic acid,2,4,5-trihydroxybenzoic acid, 3-O-methylgallic acid (3-OMGA),4-O-methylgallic acid (4-OMGA), 3,4-O-dimethylgallic acid, syringicacid, and 3,4,5-trimethoxybenzoic acid.

Some examples of aminobenzoates of the present technology include, butare not limited to, anthranilic acid, 3-aminobenzoic acid,4,5-dimethylanthranilic acid, N-methylanthranilic acid,N-acetylanthranilic acid, fenamic acids (e.g., tolfenamic acid,mefenamic acid, flufenamic acid), 2,4-diaminobenzoic acid (2,4-DABA),2-acetylamino-4-aminobenzoic acid, 4-acetylamino-2-aminobenzoic acid,and 2,4-diacetylaminobenzoic acid.

Some examples of aminohydroxybenzoates of the present technologyinclude, but are not limited to, 4-aminosalicylic acid,3-hydroxyanthranilic acid, and 3-methoxyanthranilic acid.

Heteroaryl Carboxylic Acids

The general structures of some heteroaryl carboxylic acids of thepresent technology are represented by the following general formula V,VI, VII, VIII, IX, X, XI, XII, or XIII:

where R¹, R² and R³ are defined as above.

Suitable examples of heteroaryl carboxylic acids of the presenttechnology are pyridine derivatives, some of which are involved innicotinate and tryptophan metabolism. In these compounds at least onecarbon of the phenyl ring is replaced by a nitrogen atom. Besides thecarboxyl group, this set of compounds of the present technology can haveadditional substituents, preferably but not limited to hydroxyl groups.

Some examples of heteroaryl carboxylic acids of the present technologyinclude, but are not limited to, nicotinic acid (niacin), isonicotinicacid, picolinic acid, 3-hydroxypicolinic acid, 6-hydroxynicotinic acid,citrazinic acid, 2,6-dihydroxynicotinic acid, kynurenic acid,xanthurenic acid, 6-hydroxykynurenic acid, 8-methoxykynurenic acid,7,8-dihydroxykynurenic acid, and 7,8-dihydro-7,8-dihydroxykynurenicacid.

Phenylacetates

In some embodiments of the present technology, the aryl carboxylic acidsof the present technology comprise a carboxylic group that is separatedby one carbon from the aryl moiety. These aryl carboxylic acids includebranched phenylpropionic acids (i.e., 2-methyl-2-phenylacetates) orother derivatives of phenylacetate (FIG. 4). The general structure of atleast one phenylacetate of the present technology is represented by thefollowing general formula II:

where R¹, R², R³ and R⁴ are defined as above.

Phenylacetic acids encompass various subsets of natural products,metabolites and pharmaceuticals. One such pharmaceutically importantsubset is “profens”, a type of NSAIDs and derivatives of certainphenylpropionic acids (e.g., 2-methyl-2-phenylacetic acid analogs). Someother phenylacetates have central functions in the phenylalanine andtyrosine metabolism.

Some examples of phenylacetates of the present technology include, butare not limited to, phenylacetic acid (hydratropic acid),2-hydroxyphenylacetic acid, 3-hydroxyphenylacetic acid,4-hydroxyphenylacetic acid, homoprotocatechuic acid, homogentisic acid,2,6-dihydroxyphenylacetic acid, homovanillic acid, homoisovanillic acid,homoveratric acid, atropic acid, d,l-tropic acid, diclofenac,d,l-mandelic acid, 3,4-dihydroxy-d,l-mandelic acid,vanillyl-d,l-mandelic acid, isovanillyl-d,l-mandelic acid, ibuprofen,fenoprofen, carprofen, flurbiprofen, ketoprofen, and naproxen.

Benzylacetates

In additional embodiments, the aryl carboxylic acids of the presenttechnology comprise a carboxylic group that is separated by two carbonsfrom the aryl moiety. These aryl carboxylic acids include benzylacetatesand substituted derivatives thereof and analogs of cinnamic acid (FIG.5). Both classes of compounds are abundant in nature in the form ofnatural products or metabolites (e.g., phenylalanine metabolism). Thegeneral structures of some benzylacetates and cinnamates of the presenttechnology are represented by the following general formulas (III) and(IV):

where R¹, R², R³ and R⁴ are defined as above.

Benzylacetic acids are defined by an ethylene group between the carboxylfunction and the phenyl ring. Both the alkyl chain and the aryl moietycan have substituents, preferably hydroxyl groups. Some compounds ofthis class can be found in the phenylalanine metabolism.

Some examples of benzylacetates of the present technology include, butare not limited to, benzylacetic acid, melilotic acid,3-hydroxyphenylpropanoic acid, 4-hydroxyphenylpropanoic acid,2,3-dihydroxyphenylpropanoic acid, d,l-phenyllactic acid,o,m,p-hydroxy-d,l-phenyllactic acid, phenylpyruvic acid.

Cinnamates

Cinnamic acids (3-phenylacrylic acids) are unsaturated analogs ofbenzylacetic acids. Cinnamates occur in two isomeric forms: cis (Z) andtrans (E). The cinnamate isomers of certain embodiments of the presenttechnology are preferably, but not limited to, the trans configuration.Similar to benzylacetates, derivatives of cinnamic acid can besubstituted on the alkenyl or aryl moiety of the molecule. Preferredsubstituents of some embodiments of the present technology are hydroxyland methoxy groups. Certain cinnamates are thought to play a key role inphenylalanine metabolism.

Some examples of cinnamates of the present technology include, but arenot limited to, cinnamic acid, o,m,p-coumaric acid,2,3-dihydroxycinnamic acid, 2,6-dihydroxycinnamic acid, caffeic acid,ferulic acid, isoferulic acid, 5-hydroxyferulic acid, sinapic acid,2-hydroxy-3-phenylpropenoic acid.

Physiological Benefits

In certain embodiments, the hydromorphone prodrugs and compositions ofthe present technology can be given orally and, upon administration,release the active hydromorphone after being hydrolyzed in the body.Since the aryl carboxylic acids of this invention are naturallyoccurring metabolites or mimetics thereof or pharmaceutically activecompounds, these prodrugs can be easily recognized by physiologicalsystems resulting in hydrolysis and release of hydromorphone. Theprodrugs of the present technology, in certain embodiments, are eithernot active or have limited pharmacological activity and consequently mayfollow a metabolic pathway that differs from the parent drug. Bychoosing suitable aryl carboxylic acids (“ligands”) of the presenttechnology the release of hydromorphone into the systemic circulationcan be controlled even when the prodrug is administered via routes otherthan oral.

In at least one embodiment, the hydromorphone prodrugs of the presenttechnology release hydromorphone in a manner that is similar to free orunmodified hydromorphone. In another embodiment, hydromorphone prodrugsof the present technology release hydromorphone in a controlled orsustained form. This controlled release can potentially alleviatecertain side effects and improve upon the safety profile of the parentdrug. Side effects that are alleviated by the present technology mayinclude, dizziness, lightheadedness, drowsiness, nausea, vomiting,constipation, stomach pain, rash, difficulty urinating, difficultybreathing and fainting.

In addition, hydromorphone and other opioids are also highly addictiveand prone to substance abuse. Recreational drug abuse of opioids is acommon problem and usually begins with oral doses taken with the purposeof achieving euphoria (“rush”, “high”). Over time the drug abuser oftenincreases the oral dosages to attain more powerful “highs” or tocompensate for heightened opioid tolerance. Rapid metabolism and fastduration of action of hydromorphone, contributes to its likelihood ofbeing abused. This behavior can escalate and result in exploring ofother routes of administration such as intranasal (“snorting”) andintravenous (“shooting”).

In some embodiments of the present technology, hydromorphone that isconjugated with a suitable aryl carboxylic acid ligand exhibits no rapidspikes in blood levels after oral administration that is sought by apotential drug abuser. In certain embodiments, the prodrugs of thepresent technology exhibit a delayed T_(max) and lower C_(max) valuecompared to an equimolar dose of the parent drug. Therefore, the feelingof a “rush” is lacking when prodrugs of the present technology are takenorally even at higher doses while pain relief is still achieved.

In other embodiments, hydromorphone conjugates of the present technologyare not hydrolyzed efficiently when administered via non-oral routes. Asa result, the prodrugs of the present technology do not generate highplasma or blood concentrations of released hydromorphone when injectedor snorted compared to free hydromorphone administered through theseroutes. Furthermore, since the ligands of certain embodiments of thepresent technology are bound covalently to hydromorphone, the opioid isnot liberated by any type of physical manipulation. This provides anadvantage to the prodrugs of the present technology compared to otherformulated hydromorphone that release free hydromorphone upon physicalmanipulation (e.g., grinding, crushing, etc.).

In at least one embodiment, the prodrugs of the present technology haveno or insignificant activity at the μ-opioid receptors. In anotherembodiment, prodrugs of the present technology are not subjected toenzymatic hydrolysis until they are absorbed in the gut. Without beingbound by theory, it is believed that the active hydromorphone of theprodrugs of the present technology is effectively “cloaked” by theattached aryl carboxylic acid and may bypass the peripheral μ-opioidreceptors without affecting the ENS thereby reducing or preventing OIC.

Hydromorphone is extensively metabolized in the liver tohydromorphone-3-glucuronide (H3G). Although H3G has no analgesicactivity, it may cause neuroexcitation, agitation, confusion andhallucinations. If H3G can cross the blood-brain-barrier (BBB), it mayaccumulate in the central nervous system (CNS) and result in myoclonus,allodynia and seizures as observed in patients dosed chronically withhigh doses of hydromorphone. This effect may be enhanced in patientswith renal dysfunction.

In at least one other embodiment, the prodrugs of the present technologyresult in decreased conversion of hydromorphone to H3G after oraladministration when compared to unconjugated hydromorphone. Withoutbeing bound by theory, it is believed that this may result in animproved side effect profile, particularly alleviated neuroexcitatorybehaviors compared to free hydromorphone.

Formulations

The compositions and prodrugs of the present technology can be oraldosage forms. These dosage forms include but are not limited to tablet,capsule, softgel, caplet, troche, lozenge, powder, suspension, syrup,solution or oral thin film (OTF). Preferred oral administration formsare capsule, tablet, solutions and OTF.

The compositions and prodrugs of the present technology can also besolid dosage forms that include excipients. Excipients of the presenttechnology include, but are not limited to, antiadherents, binders,coatings, disintegrants, fillers, flavors and colors, glidants,lubricants, preservatives, sorbents and sweeteners.

Oral formulations of the present technology can also be included in asolution or a suspension in an aqueous liquid or a non-aqueous liquid.The formulation can be an emulsion, such as an oil-in-water liquidemulsion or a water-in-oil liquid emulsion. The oils can be administeredby adding the purified and sterilized liquids to a prepared enteralformula, which is then placed in the feeding tube of a patient that isunable to swallow.

Softgel or soft gelatin capsules may be prepared, for example bydispersing the formulation in an appropriate vehicle (vegetable oils arecommonly used) to form a high viscosity mixture. This mixture is thenencapsulated with a gelatin based film using technology and machineryknown to those in the soft gel industry. The individual units so formedare then dried to constant weight.

Chewable tablets, for example, may be prepared by mixing theformulations with excipients designed to form a relatively soft,flavored, tablet dosage form that is intended to be chewed rather thanswallowed. Conventional tablet machinery and procedures, for example,direct compression and granulation, i.e., slugging, before compression,can be utilized. Those individuals involved in pharmaceutical soliddosage form production are versed in the processes and the machineryused, as the chewable dosage form is a very common dosage form in thepharmaceutical industry.

Film coated tablets, for example, may be prepared by coating tabletsusing techniques such as rotating pan coating methods or air suspensionmethods to deposit a contiguous film layer on a tablet.

Compressed tablets, for example may be prepared by mixing theformulation with excipients intended to add binding qualities todisintegration qualities. The mixture is either directly compressed orgranulated and then compressed using methods and machinery known tothose of skill in the industry. The resultant compressed tablet dosageunits are then packaged according to market need, for example, in unitdose, rolls, bulk bottles, blister packs, etc.

The present technology also contemplates the use ofbiologically-acceptable carriers which may be prepared from a wide rangeof materials. Without being limited to, such materials include diluents,binders and adhesives, lubricants, plasticizers, disintegrants,colorants, bulking substances, flavorings, sweeteners and miscellaneousmaterials such as buffers and adsorbents in order to prepare aparticular medicated composition.

Binders of the present technology may be selected from a wide range ofmaterials such as hydroxypropylmethylcellulose, ethylcellulose, or othersuitable cellulose derivatives, povidone, acrylic and methacrylic acidco-polymers, pharmaceutical glaze, gums, milk derivatives, such as whey,starches, and derivatives, as well as other conventional binders knownto persons working in the art. Exemplary non-limiting solvents arewater, ethanol, isopropyl alcohol, methylene chloride or mixtures andcombinations thereof. Exemplary non-limiting bulking substances includesugar, lactose, gelatin, starch, and silicon dioxide.

It should be understood that in addition to the ingredients particularlymentioned above, the formulations of the present technology can includeother suitable agents such as flavoring agents, preservatives andantioxidants. Such antioxidants would be food acceptable and couldinclude vitamin E, carotene, BHT or other antioxidants.

Other compounds which may be included by admixture are, for example,medically inert ingredients, e.g., solid and liquid diluents, such aslactose, dextrose, saccharose, cellulose, starch or calcium phosphatefor tablets or capsules, olive oil or ethyl oleate for soft capsules andwater or vegetable oil for suspensions or emulsions; lubricating agentssuch as silica, talc, stearic acid, magnesium or calcium stearate and/orpolyethylene glycols; gelling agents such as colloidal clays; thickeningagents such as gum tragacanth or sodium alginate, binding agents such asstarches, arabic gums, gelatin, methylcellulose, carboxymethylcelluloseor polyvinylpyrrolidone; disintegrating agents such as starch, alginicacid, alginates or sodium starch glycolate; effervescing mixtures;dyestuff; sweeteners; wetting agents such as lecithin, polysorbates orlaurylsulfates; and other therapeutically acceptable accessoryingredients, such as humectants, preservatives, buffers andantioxidants, which are known additives for such formulations.

For oral administration, fine powders or granules containing diluting,dispersing and/or surface-active agents may be presented in a draught,in water or syrup, in capsules or sachets in the dry state, in anon-aqueous suspension wherein suspending agents may be included, or ina suspension in water or syrup. Where desirable, flavoring, preserving,suspending, thickening or emulsifying agents can be included.

Liquid dispersions for oral administration may be syrups, emulsions orsuspensions. The syrups may contain as carrier, for example, saccharoseor saccharose with glycerol and/or mannitol and/or sorbitol. Inparticular syrup for diabetic patients can contain as carriers onlyproducts, for example sorbitol, which do not metabolize to glucose orwhich metabolize only a very small amount to glucose. The suspensionsand the emulsions may contain a carrier, for example a natural gum,agar, sodium alginate, pectin, methylcellulose, carboxymethylcelluloseor polyvinyl alcohol.

Current approved formulations of hydromorphone are tablets, capsules,modified release capsules, extended release tablets, controlled releasecapsules, suppository, powder for injection, oral liquid, cough syrup,and injections. The conjugated hydromorphone of the present technology,in certain embodiments, can be formulated into any of these currentlyapproved unconjugated hydromorphone formulations.

Other current approved formulations of hydromorphone are combinationtherapies of hydromorphone and one or more other non-narcotic activeingredient depending on intended indication. Examples of these activepharmaceuticals include, but are not limited to, acetaminophen,ibuprofen, and aspirin. The conjugated hydromorphone of the presenttechnology can be formulated with one or a combination of these or otheractive substances or as a standalone active ingredient without any otheractives.

Methods of Use

The conjugate compositions or prodrugs of the present technology may beused in methods of treating a patient having a disease, disorder orcondition requiring or mediated by binding or inhibiting binding of anopioid to the opioid receptors of the patient. Treatment comprisesorally administering to the patient at least one conjugate ofhydromorphone as described in the present technology in an amounttherapeutically equivalent to an effective amount of unconjugatedhydromorphone. The conjugate can exhibit reduced peak plasmaconcentrations (C_(max)) and lower area under the curve (AUC) ofreleased hydromorphone when administered via non-oral routes, such asintranasal and intravenous, compared to an equivalent molar amount ofunconjugated hydromorphone. In some aspects, oral administration of atleast one conjugate can provide an extended rate of release ofhydromorphone over time and a therapeutically bioequivalent AUC withlittle or no spike in C_(max) or equivalent C_(max) value when comparedto other controlled release forms of hydromorphone (e.g., Exalgo®). Inother embodiments, at least one conjugate can exhibit less variabilityin plasma concentrations of hydromorphone after oral administration whencompared to unconjugated hydromorphone.

In other embodiments, at least one conjugate is provided in an amountsufficient to provide a therapeutically bioequivalent AUC (area underthe curve) of hydromorphone when compared to a molar equivalent amountof unconjugated hydromorphone. In further embodiments, the conjugate isprovided in an amount sufficient to provide a therapeuticallybioequivalent AUC of hydromorphone when compared to a molar equivalentamount of unconjugated hydromorphone but has a lower C_(max) (peakconcentration) value of hydromorphone in plasma or does not provide anequivalent C_(max) value in plasma. In some aspects, the conjugate isprovided in an amount sufficient to provide a therapeuticallybioequivalent C_(max) value of hydromorphone when compared to a molarequivalent amount of unconjugated hydromorphone. In further embodiments,at least one conjugate is provided in an amount sufficient to provide anincreased AUC or increased C_(max) value of hydromorphone, or both, whencompared to a molar equivalent amount of unconjugated hydromorphone.

In further aspects, at least one conjugate is provided in an amounttherapeutically equivalent to an effective amount of unconjugatedhydromorphone but reduces or prevents opioid induced constipation (OIC).In some embodiments, at least one conjugate is provided in an amounttherapeutically equivalent to an effective amount of unconjugatedhydromorphone but decreases or prevents neuroexcitatory toxicity causedby hydromorphone-3-glucuronide.

Suitable diseases, disorders or conditions that can be treated by theprodrugs or compositions of the present technology are narcotic or drugaddiction, acute or chronic pain and severe coughs.

Dosages for the conjugates of the present technology depend on theirmolecular weight and the respective weight-percentage of hydromorphoneas part of the whole conjugate, and therefore can be higher than thedosages of free hydromorphone.

Adult oral dosage strengths based on hydromorphone hydrochloride rangebetween 2 mg and 16 mg per dose for immediate release and 8 mg to 64 mgper dose for extended release formulations. Pediatric oral doses rangefrom 0.03 mg/kg/dose to 0.08 mg/kg/dose for children and adolescentsless than 50 kg and 1 mg to 2 mg per dose for pediatrics greater than 50kg. Pediatric oral doses for cough suppression range from 0.5 mg to 1 mgper dose. Doses should be titrated to appropriate analgesic effectswhile minimizing adverse effects. Dosages for the prodrugs of thepresent technology can be higher depending on their molecular weight andthe respective weight-percentage of hydromorphone as part of the wholeconjugate. Dose conversion from hydromorphone hydrochloride tohydromorphone prodrug can be performed using the following formula:

${{dose}\left( {{HM}\mspace{11mu}{prodrug}} \right)} = {f_{BA} \times {{dose}\left( {{HM} \cdot {HCl}} \right)} \times \frac{{MW}\left( {{HM}\mspace{11mu}{prodrug}} \right)}{321.80\mspace{14mu}\frac{g}{mol}}}$HM=hydromorphoneHCl=hydrochlorideMW=molecular weightf_(BA)=correction factor accounting for differences in bioavailabilitybetween unmodified hydromorphone and prodrugs of this invention. Thiscorrection factor is specific for each prodrug of the presenttechnology.

Suitable dosages of the conjugated hydromorphone of the presenttechnology include, but are not limited to, formulations including fromabout 0.1 mg or higher, alternatively from about 0.5 mg or higher,alternatively from about 2.5 mg or higher, alternatively from about 5.0mg or higher, alternatively from about 7.5 mg or higher, alternativelyfrom about 10 mg or higher, alternatively from about 20 mg or higher,alternatively from about 30 mg or higher, alternatively from about 40 mgor higher, alternatively from about 50 mg or higher, alternatively fromabout 60 mg or higher, alternatively from about 70 mg or higher,alternatively from about 80 mg or higher, alternatively from about 90 mgor higher, alternatively from about 100 mg or higher, alternatively fromabout 150 mg or higher, alternatively from about 200 mg or higher, andinclude any additional increments thereof, for example, 0.1, 0.2, 0.25,0.3, 0.4, 0.5, 0.6, 0.7, 0.75, 0.8, 0.9 or 1.0 mg and multiplied factorsthereof, (e.g., ×1, ×2, ×2.5, ×5, ×10, ×100, etc).

In another aspect, the amount per unit dose is based on the content offree or unconjugated hydromorphone in the conjugate of hydromorphone.

The present technology also includes dosage formulations includingcurrently approved formulations of hydromorphone, where the dosage canbe calculated using the above-noted formula determined by the amount ofhydromorphone. The present technology provides for dosage formsformulated as a single therapy or as a combination therapy with otheractive pharmaceutical ingredients (APIs).

The prodrugs of the present technology may be administered for therelief of pain or cough depression or for the treatment of any conditionthat may require the blocking of opioid receptors.

The conjugates of the present technology can provide a decrease in sideeffects of the opioid analgesic, including reduced or inhibitedconstipatory effects.

General Synthetic Procedures

The present technology also provides a method of synthesis for thepreparation of the conjugated hydromorphone of the present technology.In certain embodiments, the synthesis of the prodrugs of the presenttechnology includes the steps of:

Phenol ester conjugates (3-ligand-HM):

-   -   1. Protection of the ligand, if necessary.    -   2. Activation of the ligand carboxylic acid group, if necessary.    -   3. Addition of the activated ligand to hydromorphone or vice        versa in the presence of base.    -   4. Removal of ligand protecting group(s), if applicable.

Enol ester conjugates (6-ligand-HM):

-   -   1. Protection of the ligand, if necessary.    -   2. Activation of the ligand carboxylic acid group, if necessary.    -   3. Protection of the phenolic (3-OH) hydroxyl group of        hydromorphone, if necessary.    -   4. Addition of the activated ligand to hydromorphone or vice        versa in the presence of base.    -   5. Removal of ligand and/or hydromorphone protecting group(s),        if applicable.

Phenol ester/enol ester di-conjugates (3,6-di-ligand-HM):

-   -   1. Protection of the ligand, if necessary.    -   2. Activation of the ligand carboxylic acid group, if necessary.    -   3. Addition of the activated ligand to hydromorphone or vice        versa in the presence of base.    -   4. Removal of ligand protecting group(s), if applicable.

If the aryl carboxylic acid contains any additional reactive functionalgroups that may interfere with the coupling to hydromorphone, it may benecessary to first attach one or more protecting groups. Any suitableprotecting group may be used depending on the type of functional groupand reaction conditions. Some protecting group examples are: acetyl(Ac), β-methoxyethoxymethyl ether (MEM), methoxymethyl ether (MOM),p-methoxybenzyl ether (PMB), trimethylsilyl (TMS),tert.-butyldimethylsilyl (TBDPS), triisopropylsilyl (TIPS),carbobenzyloxy (Cbz), p-methoxybenzyl carbonyl (Moz),tert.-butyloxycarbonyl (Boc), 9-fluorenylmethyloxycarbonyl (Fmoc),benzyl (Bn), p-methoxybenzyl (MPM), tosyl (Ts). Temporary formation ofacetals or ketals from carbonyl functions may also be appropriate.

The carboxylic acid group of the ligands may need to be activated inorder to react with hydromorphone and to generate appreciable amounts ofconjugate. This activation can be accomplished in numerous ways by avariety of coupling agents known to one skilled in the art. Examples ofsuch coupling agents are: N,N-dicyclohexylcarbodiimide (DCC),N-(3-dimethylaminopropyl)-N′-ethylcarbodiimide (EDCI),N,N′-diisopropylcarbodiimide (DIC), 1,1′-carbonyldiimidazole (CDI) orother carbodiimides;(benzotriazol-1-yloxy)tris(dimethylamino)phosphonium hexafluorophosphate(BOP), bromotripyrrolidinophosphonium hexafluorophosphate (PyBroP),(benzotriazol-1-yloxy)tripyrrolidinophosphonium hexafluorophosphate(PyBOP) or other phosphonium-based reagents;O-(benzotriazol-1-yl)-N,N,N′,N′-tetramethyluronium hexafluorophosphate(HBTU), O-(benzotriazol-1-yl)-N,N,N′,N′-tetramethyluroniumtetrafluoroborate (TBTU), fluoro-N,N,N′,N′-tetramethylformamidiniumhexafluorophosphate (TFFH),N,N,N′,N′-tetramethyl-O—(N-succinimidyl)uronium tetrafluoroborate (TSTU)or other aminium-based reagents. The aryl carboxylic acid can also beconverted to a suitable acyl halide, acyl azide or mixed anhydride.

A base may be required at any step in the synthetic scheme of an arylcarboxylic acid conjugate of hydromorphone. Suitable bases include butare not limited to: 4-methylmorpholine (NMM), 4-(dimethylamino)pyridine(DMAP), N,N-diisopropylethylamine, lithium bis(trimethylsilyl)amide,lithium diisopropylamide (LDA), any alkali metal tert.-butoxide (e.g.,potassium tert.-butoxide), any alkali metal hydride (e.g., sodiumhydride), any alkali metal alkoxide (e.g., sodium methoxide),triethylamine or any other tertiary amine.

Suitable solvents that can be used for any reaction in the syntheticscheme of an aryl carboxylic acid conjugate of hydromorphone include butare not limited to: acetone, acetonitrile, butanol, chloroform,dichloromethane, dimethylformamide (DMF), dimethylsulfoxide (DMSO),dioxane, ethanol, ethyl acetate, diethyl ether, heptane, hexane,methanol, methyl tert.-butyl ether (MTBE), isopropanol, isopropylacetate, diisopropyl ether, tetrahydrofuran, toluene, xylene or water.

Pharmaceutical Kits

The present technology also provides pharmaceutical kits for thetreatment or prevention of drug withdrawal symptoms or pain in apatient. The patient may be a human or animal patient. Suitable humanpatients include pediatric patients, geriatric (elderly) patients, andnormative patients. The kit comprises a specific amount of theindividual doses in a package containing a pharmaceutically effectiveamount of at least one conjugate of hydromorphone of the presenttechnology. The kit can further include instructions for use of the kit.The specified amount of individual doses may contain from about 1 toabout 100 individual dosages, alternatively from about 1 to about 60individual dosages, alternatively from about 10 to about 30 individualdosages, including, about 1, about 2, about 5, about 10, about 15, about20, about 25, about 30, about 35, about 40, about 45, about 50, about55, about 60, about 70, about 80, about 100, and include any additionalincrements thereof, for example, 1, 2, 5, 10 and multiplied factorsthereof, (e.g., ×1, ×2, ×2.5, ×5, ×10, ×100, etc).

The presently described technology and its advantages will be betterunderstood by reference to the following examples. These examples areprovided to describe specific embodiments of the present technology. Byproviding these specific examples, it is not intended limit the scopeand spirit of the present technology. It will be understood by thoseskilled in the art that the full scope of the presently describedtechnology encompasses the subject matter defined by the claimsappending this specification, and any alterations, modifications, orequivalents of those claims.

EXAMPLES Example 1: Oral Pharmacokinetic Study

Certain prodrug conjugates of the present technology were dosed as oralsolutions in rats and compared to an equimolar solution of hydromorphonehydrochloride. The oral studies were performed at doses equimolar to 2.0mg/kg of hydromorphone. The release of hydromorphone from the prodrugsvaried depending on the ligand attached to hydromorphone. Exposures tohydromorphone released from the prodrugs in the presented examplesranged from 45%-AUC to 113% %-AUC, %-C_(max) from 37% to 185% and%-T_(max) from 13% to 200% compared to unconjugated hydromorphonehydrochloride. The PK profile curves are presented in FIGS. 8-15 and thePK parameters are summarized in Table 1 below.

TABLE 1 PK parameters of hydromorphone released from the hydromorphoneconjugates (rat studies). AUC C_(max) [ng/ [ng/ T_(max) %-AUC %-C_(max)%-T_(max) Conjugate mL × h] mL] [h] of HM of HM of HM 3-Aspirin-HM 55.944.3 0.250 76% 133% 25% 3,6-di-Aspirin-HM 82.4 36.5 0.250 113% 109% 25%6-o-Salicylate-HM 33.3 14.1 0.250 101% 51% 100% 3-Cinnamate-HM 25.3 28.30.250 45% 62% 100% 6-Naproxen-HM 31.6 19.1 0.250 54% 94% 100%3-Isoniacin-HM 25.1 18.5 0.250 76% 66% 100% 3-p-Salicylic-HM 31.4 17.20.250 60% 74% 100% 3-Fenamate-HM 44.6 30.6 0.250 94% 185% 13%3-Benzoate-HM 41.2 19.8 0.500 72% 64% 200% 3,6-di-Benzoate-HM 30.1 11.30.250 53% 37% 100%

The hydromorphone plasma concentrations produced by 3-cinnamate-HM,3-p-salicylate-HM, 3-benzoate-HM and 3,6-di-benzoate-HM were lower atall time points when compared to unconjugated hydromorphone. The C_(max)value of hydromorphone released from 6-naproxen-HM was similar to thepeak plasma concentration of unconjugated hydromorphone, but the overallexposure after oral administration of this conjugate was reducedsignificantly compared to the parent drug. The hydromorphone plasmaconcentrations generated by 6-o-salicylate-HM and 3-isoniacin-HM weresimilar to unconjugated hydromorphone, except for a considerabledecrease at the first time point (0.25 hours) resulting in a lowerC_(max) value for these two conjugates. The plasma concentrations ofhydromorphone released from 3-fenamate-HM were elevated for the firsthour after oral administration and then decreased quickly when comparedto unconjugated hydromorphone. The hydromorphone plasma concentrationswere comparable after oral administration of 3-aspirin-HM,3,6-di-aspirin-HM and unconjugated hydromorphone.

Example 2: Intranasal Pharmacokinetic Study

Certain prodrug conjugates of the present technology were dosed asintranasal solutions in rats and compared to an equimolar solution ofhydromorphone hydrochloride. The intranasal studies were performed atdoses equimolar to 2.0 mg/kg of hydromorphone. The release ofhydromorphone from the prodrugs varied depending on the ligand attachedto hydromorphone.

Plasma concentrations of hydromorphone after intranasal administrationof 3,6-di-aspirin-HM were significantly reduced when compared to theparent drug (FIG. 16). The AUC and C_(max) values of 3,6-di-aspirin-HMwere 17% and 20% of the respective PK parameters of unconjugatedhydromorphone.

Example 3: Intravenous Pharmacokinetic Study

Certain prodrug conjugates of the present technology were dosed asintravenous solutions in rats and compared to an equimolar solution ofhydromorphone hydrochloride. The release of hydromorphone from theprodrugs varied depending on the ligand attached to hydromorphone.

Hydromorphone and 3,6-di-aspirin-HM were dosed intravenously in rats at0.20 mg/kg. Plasma concentrations of hydromorphone after intravenousadministration of 3,6-di-aspirin-HM were significantly lower whencompared to unconjugated hydromorphone (FIG. 17). The AUC and C_(max)values of 3,6-di-aspirin-HM were 6% and 3% of the respective PKparameters of unconjugated hydromorphone.

Example 4: Dose Escalation Study

Certain prodrug conjugates of the present technology were dosed atescalating dosages as oral solutions in rats. When 3,6-di-aspirin-HM wasdosed above the therapeutic level, the exposure (AUC) to hydromorphonereached a plateau. However, after oral administration of hydromorphonehydrochloride, the exposure (AUC) to hydromorphone remainedapproximately dose proportional even above the therapeutic level andcaused death of the test animals with dosages above 14 mg/kg (see FIG.18). These data suggest that 3,6-di-aspirin-HM has a decreased potentialfor causing overdose when compared to hydromorphone hydrochloride.

Without being bound by theory, it is believed that the exposure (AUC)plateau seen when 3,6-di-aspirin-HM was dosed above the therapeuticlevel is due to saturation of hydrolytic enzymes.

Example 5: Tamper Resistance Study

Certain prodrug conjugates of the present technology were exposed tovarious commonly applied “extraction methods” to test for hydrolysisand/or decomposition of the prodrug. Solvent extraction of3,6-di-aspirin-HM from formulation only yielded inactive prodrug withinherent pharmacological abuse protection. This shows that hydromorphonecannot be released from 3,6-di-aspirin-HM through physical manipulationor solvent extraction. In addition, 3,6-di-aspirin-HM is chemicallystable under commonly applied “extraction methods” and only hydrolyzedand/or decomposed under extremely harsh conditions yielding a complexmixture of decomposition products in highly acidic or caustic solutions.Additionally, the decomposition products exhibited reduced oral, IN andIV bioavailability making extraction inefficient and impractical. Theresults of the extraction study are summarized in Table 2 below.

TABLE 2 Release of 3,6-di-aspirin-HM from formulation Condition AmbientTemperature (Common Methods) 30 min. 60 min. 1N HCl 0 0 Glacial aceticacid 0 0 5% Acetic acid 0 0 Water 0 0 Sat. NaHCO₃ 0 0 1N NaOH 1% 1% 4NNaOH 1% 6% Numbers represent amount of hydromorphone released from3,6-di-aspirin-HM (as %-AUC by HPLC)

In addition, 3,6-di-aspirin-HM was exposed to 16 harsh, hydrolyticconditions and the resulting breakdown products were monitored andquantified by HPLC. Besides hydromorphone, three intermediate breakdownproducts were observed and then synthesized and dosed orally in rats.For each hydrolytic condition, virtual AUC and C_(max) values werecalculated based on the composition of the observed mixture and on theindividual PK parameters for each of its components (see FIG. 19). Thesedata show that tampering with 3,6-di-aspirin-HM produces a mixture ofcompounds that when taken orally results in exposure (AUC) ofhydromorphone that is lower than the exposure (AUC) seen withhydromorphone hydrochloride or untampered 3,6-di-aspirin-HM and in amaximum exposure (C_(max)) of hydromorphone that is lower than themaximum exposure (C_(max)) seen with hydromorphone hydrochloride.

Example 6: Opioid Induced Constipation Study

Receptor binding assays and validated rat gastrointestinal (GI) motilitystudies were performed with certain prodrug conjugates of the presenttechnology. The receptor binding assays showed that 3,6-di-aspirin-HMhas insignificant affinity to the enteric μ-opioid receptors that arelocated in the gut.

The validated rat motility study demonstrated that at equimolar does,3,6-di-aspirin-HM reduces GI transit to a lesser extent thanhydromorphone hydrochloride. The effect of 3,6-di-aspirin-HM on motilitywas similar to hydromorphone hydrochloride only when 3,6-di-aspirin-HMwas given at twice the equimolar dose of the parent drug (FIG. 20). Thisdata suggests that 3,6-di-aspirin-HM possesses the potential to reduceor eliminate the opioid-induced constipation (OIC) associated withadministration of unconjugated hydromorphone.

Without being bound by theory, it is believed that 3,6-di-aspirin-HMstays mostly intact until absorbed into the intestinal mucosa where itis converted to hydromorphone after bypassing the peripheral opioidreceptors. Again, without being bound by theory, it is also believedthat the released hydromorphone subsequently passes through thebasolateral membrane into the systemic circulation. This theoreticalmechanism is consistent with the potential for reduction or preventionof opioid-induced constipation associated with administration of3,6-di-aspirin-HM compared to unconjugated hydromorphone.

Example 7: Certain Synthetic Schemes Synthesis of 3-aspirin-HM.HCl (FIG.21A)

Triethylamine (0.42 mL, 3 mmol) was added to hydromorphone hydrochloride(0.322 g, 1 mmol) in dichloromethane (10 mL) followed byO-acetylsalicyloyl chloride (0.248 g, 1.25 mmol). The reaction wasstirred at room temperature for 4 hours. The mixture was poured intoethyl acetate (100 mL) and washed with aqueous saturated NaHCO₃ (30mL×3) and brine (30 mL). The organic layer was dried over anhydrousNa₂SO₄ and concentrated. The residue was purified by columnchromatography (8% methanol in dichloromethane) to give 0.385 g of anamorphous solid, which was dissolved in methanol (6 mL) and then treatedwith 1 N HCl/MeOH (1.3 mL). The solvent was evaporated and TBME (6 mL)was added to the residue. The resulting white solid was collected andrinsed with TBME (1 mL×2). The yield was 0.395 g (81.6%).

Synthesis of 3-cinnamate-HM.HCl (FIG. 21B)

The compound was synthesized using the same procedure as for3-aspirin-HM, except the O-acetylsalicyloyl chloride was replaced bycinnamoyl chloride. The yield was 65.2%.

Synthesis of 3-benzoate-HM.HCl (FIG. 21C)

The compound was synthesized using the same procedure as for3-aspirin-HM, except the O-acetylsalicyloyl chloride was replaced bybenzoyl chloride. The yield was 58.9%.

Synthesis of 3,6-di-aspirin-HM.HCl (FIG. 21D)

Triethylamine (0.70 mL, 5 mmol) was added to hydromorphone hydrochloride(0.322 g, 1 mmol) in dichloromethane (15 mL) followed by DMAP (48.9 mg,0.4 mmol) and O-acetylsalicyloyl chloride (0.794 g, 4 mmol). Thereaction was stirred at room temperature for 48 hours. The mixture waspoured into ethyl acetate (100 mL) and washed with aqueous saturatedNaHCO₃ (30 mL×3) and brine (30 mL). The organic layer was dried overanhydrous Na₂SO₄ and concentrated. The residue was purified by columnchromatography (ethyl acetate and then 8% methanol in dichloromethane)and subsequently further purified by PTLC (8% methanol indichloromethane). The desired fraction was concentrated and converted toits HCl salt by adding 1 N HCl (1 mL). The solvent was evaporated and tothe residue was added ether (15 mL). The resulting solid was collectedand rinsed with ether (2 mL×3). The yield was 0.203 g (31.4%).

Synthesis of 6-salicylate-HM.HCl (FIG. 21E) Step 1 (3-MOM-HM)

0.5 M MeONa/MeOH (80 mL, 40 mmol) was added to hydromorphonehydrochloride (6.436 g, 20 mmol) in methanol (50 mL). The solvent wasevaporated and the residue was coevaporated with toluene (25 mL×2).MOMCl (1.691 g, 21 mmol) in chloroform (5 mL) was added to the resultingsolid in chloroform (100 mL) over 5 minutes while cooling in anice-bath. The reaction was stirred at room temperature overnight.Solvents were evaporated and the resulting residue was purified bycolumn (8% methanol in chloroform) yielding 5.77 g (87.5%) of an oil.

Step 2 (2-MOM-salicylic acid succinimidyl ester)

2-MOM salicylic acid (3.2 g, 17.6 mmol) and N-hydroxysuccinimide (NHS,2.23 g, 19.36 mmol) were dissolved in THF (anhydrous, 40 mL). DCC (3.99g, 19.36 mmol) was added in one portion. The reaction was stirredovernight. Solids were filtered off. The filtrate was concentrated todryness and the residue was recrystallized from methanol (10 mL). Theresulting white solid was collected and rinsed with methanol (3 mL×2).The yield was 2.599 g (52.8%).

Step 3 (3-MOM-6-(2-MOM-salicylate)-HM)

1M LiHMDS/THF (3 mL, 3 mmol) was added to 3-MOM-protected hydromorphone(0.329 g, 1 mmol) in THF (anhydrous, 8 mL) over 5 minutes while coolingin an ice-bath. The mixture was then stirred for 20 minutes at roomtemperature. Upon cooling in an ice-bath, the 2-MOM-salicylic acidsuccinimidyl ester (0.838 g, 3 mmol) was added in one portion. Thereaction was stirred for 6 hours. Saturated NH₄Cl (30 mL) was added toquench the reaction. The mixture was stirred for 30 minutes andextracted with ethyl acetate (100 mL). The acetate layer was washed withsaturated NaHCO₃ (30 mL×2) and brine (30 mL), dried over anhydrousNa₂SO₄ and concentrated. The residue was purified by column (ethylacetate and then 7% methanol in dichloromethane) yielding 100 mg of asyrup (20.2%).

Step 4 (6-Salicylate-HM.HCl)

The protected 3-MOM-6-(2-MOM-salicylate)-HM (100 mg) obtained in Step 3was dissolved in methanol (1 mL). 1.25 N HCl/MeOH (3 mL) was added tothe solution and the reaction was stirred for 3 hours. Solvents wereevaporated and the residue was dissolved in methanol (0.5 mL). Ether (15mL) was added and the resulting solid was collected by filtration andwashed with ether (1 mL×3). The yield was 75 mg (83.7%).

In the present specification, use of the singular includes the pluralexcept where specifically indicated.

The compositions, prodrugs, and methods described herein can beillustrated by the following embodiments enumerated in the numberedparagraphs that follow:

In one exemplar embodiment, the present technology is directed to aprodrug composition comprising at least one conjugate, the conjugatecomprising at least one hydromorphone, and at least one aryl carboxylicacid. Further, the prodrug composition may also contain at least onehydromorphone and the at least one aryl carboxylic acid are chemicallybonded to one another by reacting the carboxylic acid moiety of the arylcarboxylic acid with the C-6 enol tautomer of hydromorphone. Further,the prodrug composition may include or utilize at least onehydromorphone and the at least one aryl carboxylic acid are chemicallybonded to one another by reacting the carboxylic acid moiety of the arylcarboxylic acid with the C-3 hydroxyl of hydromorphone. Moreover, suchexemplar prodrug composition(s) may also contain or utilize at least onehydromorphone and the at least one aryl carboxylic acid are chemicallybonded to one another by reacting the carboxylic acid moiety of one arylcarboxylic acid with the C-6 enol tautomer of hydromorphone and of onearyl carboxylic acid with the C-3 hydroxyl of hydromorphone. It shouldbe appreciated that any of the above described exemplarembodiments/compositions can include or utilize at least one arylcarboxylic acid comprises a carboxylic group attached directly to atleast one aryl moiety.

In at least one alternative exemplar embodiment of such prodrugcomposition(s), the at least one aryl carboxylic acid can be selectedfrom a group consisting of, for example, benzoates and heteroarylcarboxylic acids. In other embodiments of the prodrug composition(s) theheteroaryl carboxylic acid is selected from the group consisting ofpyridine, diazine and triazine. In some embodiments of the prodrugcomposition(s), the benzoate has the following general formula I:

wherein R¹, R² and R³ are independently selected from the groupconsisting of hydrogen, hydroxyl, amino, amine, amide, thiol, cyano,nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl,alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl,cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy,sulfonyl, phosphonate.

In additional embodiments of the prodrug composition(s) the benzoate canbe selected from the group consisting of, for example, aminobenzoates,hydroxybenzoates and aminohydroxybenzoates, mixtures thereof andderivatives thereof. Moreover, the prodrug composition(s) may contain orutilize an aminobenzoate that is selected from the group consisting of,for example, anthranilic acid, 3-aminobenzoic acid,4,5-dimethylanthranilic acid, N-methylanthranilic acid,N-acetylanthranilic acid, fenamic acids, 2,4-diaminobenzoic acid(2,4-DABA), 2-acetylamino-4-aminobenzoic acid,4-acetylamino-2-aminobenzoic acid and 2,4-diacetylaminobenzoic acid,mixtures thereof and derivatives thereof. Moreover, the prodrugcomposition(s) may contain or utilize an hydroxybenzoate that isselected from the group consisting of, for example, benzoic acid,salicylic acid, acetylsalicylic acid (aspirin), 3-hydroxybenzoic acid,4-hydroxybenzoic acid, 6-methylsalicylic acid, o,m,p-cresotinic acid,anacardic acids, 4,5-dimethylsalicylic acid, o,m,p-thymotic acid,diflusinal, o,m,p-anisic acid, 2,3-dihydroxybenzoic acid (2,3-DHB),α,β,γ-resorcylic acid, protocatechuic acid, gentisic acid, piperonylicacid, 3-methoxysalicylic acid, 4-methoxysalicylic acid,5-methoxysalicylic acid, 6-methoxysalicylic acid,3-hydroxy-2-methoxybenzoic acid, 4-hydroxy-2-methoxybenzoic acid,5-hydroxy-2-methoxybenzoic acid, vanillic acid, isovanillic acid,5-hydroxy-3-methoxybenzoic acid, 2,3-dimethoxybenzoic acid,2,4-dimethoxybenzoic acid, 2,5-dimethoxybenzoic acid,2,6-dimethoxybenzoic acid, veratric acid (3,4-dimethoxybenzoic acid),3,5-dimethoxybenzoic acid, gallic acid, 2,3,4-trihydroxybenzoic acid,2,3,6-trihydroxybenzoic acid, 2,4,5-trihydroxybenzoic acid,3-O-methylgallic acid (3-OMGA), 4-O-methylgallic acid (4-OMGA),3,4-O-dimethylgallic acid, syringic acid, and 3,4,5-trimethoxybenzoicacid, mixtures thereof and derivatives thereof. In still otheralternative embodiments, the prodrug composition(s) may contain orutilize an aminohydroxybenzoate that is selected from the groupconsisting of, for example, 4-aminosalicylic acid, 3-hydroxyanthranilicacid, and 3-methoxyanthranilic acid, mixtures thereof and derivativesthereof.

In additional embodiments, the prodrug composition(s) may contain orutilize at least one aryl carboxylic acid that comprises a carboxylicgroup that is connected by a one-carbon linker to the aryl moiety.

In other embodiments, the prodrug composition(s) may contain or utilizeat least one aryl carboxylic acid that is selected from the groupconsisting of branched phenylpropionic acids and phenylacetates,mixtures thereof and derivatives thereof. Moreover, the prodrugcomposition(s) may contain or utilize a phenylacetate that has thefollowing general structure II:

wherein R¹, R², R³ and R⁴ are independently selected from the groupconsisting of, for example, hydrogen, hydroxyl, amino, amine, amide,thiol, cyano, nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl,alkynyl, haloalkyl, alkylaryl, arylalkyl, heterocycle, arylalkoxy,cycloalkyl, cycloalkenyl, cycloalkynyl, carbonyl, thioether,selenoether, silyl, silyloxy, sulfonyl, phosphonate. In additionalembodiments, the prodrug composition(s) may contain or utilize aphenylacetate that is selected from the group consisting of, forexample, phenylacetic acid (hydratropic acid), 2-hydroxyphenylaceticacid, 3-hydroxyphenylacetic acid, 4-hydroxyphenylacetic acid,homoprotocatechuic acid, homogentisic acid, 2,6-dihydroxyphenylaceticacid, homovanillic acid, homoisovanillic acid, homoveratric acid,atropic acid, d,l-tropic acid, diclofenac, d,l-mandelic acid,3,4-dihydroxy-d,l-mandelic acid, vanillyl-d,l-mandelic acid,isovanillyl-d,l-mandelic acid, ibuprofen, fenoprofen, carprofen,flurbiprofen, ketoprofen and naproxen, mixtures thereof and derivativesthereof.

In some additional embodiments, the prodrug composition(s) may containor utilize at least one aryl carboxylic acid that comprises a carboxylicgroup that is connected by a two-carbon linker to the aryl moiety.Additionally, the prodrug composition(s) may contain or utilize whereinat least one aryl carboxylic acid that is selected from the groupconsisting of benzylacetates and cinnamates, mixtures thereof andderivatives thereof. Further, the prodrug composition(s) may contain orutilize at least one aryl carboxylic acid that is selected from thegroup consisting of, for example, benzylacetates and cinnamates havingthe following general formula III or IV or combinations thereof:

wherein R¹, R², R³ and R⁴ are independently selected from the groupconsisting of hydrogen, hydroxyl, amino, amine, amide, thiol, cyano,nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl,alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl,cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy,sulfonyl, phosphonate.

In additional embodiments, the prodrug composition(s) may contain orutilize a benzylacetate that is selected from the group consisting of,for example, benzylacetic acid, melilotic acid, 3-hydroxyphenylpropanoicacid, 4-hydroxyphenylpropanoic acid, 2,3-dihydroxyphenylpropanoic acid,d,l-phenyllactic acid, o,m,p-hydroxy-d,l-phenyllactic acid andphenylpyruvic acid, mixtures thereof and derivatives thereof. Inalternative embodiments, the prodrug composition(s) may contain orutilize a cinnamate that is selected from the group consisting of, forexample, cinnamic acid, o,m,p-coumaric acid, 2,3-dihydroxycinnamic acid,2,6-dihydroxycinnamic acid, caffeic acid, ferulic acid, isoferulic acid,5-hydroxyferulic acid, sinapic acid and 2-hydroxy-3-phenylpropenoicacid, mixtures thereof and derivatives thereof.

In some embodiments, the prodrug composition(s) may contain or utilizeat least one aryl carboxylic acid that comprises a carboxylic groupattached to an aryl moiety ring by an alkyl chain. In other embodiments,the prodrug composition(s) may contain or utilize an alkyl chain thatcomprises one carbon. In other embodiments, the prodrug composition(s)may contain or utilize an alkyl chain that comprises two carbons. Inother embodiments, the prodrug composition(s) may contain or utilize atleast one aryl carboxylic acid that comprises a carboxyl group attachedto an aryl moiety by an alkenyl chain. In further embodiments, theprodrug composition(s) may contain or utilize an alkenyl chain thatcomprises two carbons. In other embodiments, the prodrug composition(s)may contain or utilize at least one aryl carboxylic acid that comprisesone or more side chains. In additional embodiments, the prodrugcomposition(s) may contain or utilize at least one aryl carboxylic acidthat comprises one or more functional groups. In alternativeembodiments, the prodrug composition(s) may contain or utilize at leastone aryl carboxylic acid that comprises at least one heteroarylcarboxylic acid.

In some embodiments, the prodrug composition(s) may contain or utilize aheteroaryl carboxylic acid that has, for example, one of the followinggeneral formulas V, VI, VII, VIII, IX, X, XI, XII, or XIII orcombinations thereof:

wherein R¹, R² and R³ are independently selected from the groupconsisting of hydrogen, hydroxyl, amino, amine, amide, thiol, cyano,nitro, halogen, imine, alkyl, alkoxy, aryl, alkenyl, alkynyl, haloalkyl,alkylaryl, arylalkyl, heterocycle, arylalkoxy, cycloalkyl, cycloalkenyl,cycloalkynyl, carbonyl, thioether, selenoether, silyl, silyloxy,sulfonyl, phosphonate.

In other embodiments, the prodrug composition(s) may contain or utilizea heteroaryl group that comprises one heteroatom. In furtherembodiments, the prodrug composition(s) may contain or utilize aheteroaryl carboxylic acid that is, for example, at least one pyridineor pyridine derivative. In additional embodiments, the prodrugcomposition(s) may contain or utilize a heteroaryl carboxylic acid thatis selected from the group consisting of, for example, nicotinic acid(niacin), isonicotinic acid, picolinic acid, 3-hydroxypicolinic acid,6-hydroxynicotinic acid, citrazinic acid, 2,6-dihydroxynicotinic acid,kynurenic acid, xanthurenic acid, 6-hydroxykynurenic acid,8-methoxykynurenic acid, 7,8-dihydroxykynurenic acid and7,8-dihydro-7,8-dihydroxykynurenic acid, mixtures thereof andderivatives thereof.

In other embodiments, the prodrug composition(s) may contain or utilizea heteroaryl group that comprises two heteroatoms. In furtherembodiments, the prodrug composition(s) may contain or utilize aheteroaryl carboxylic acid is, for example, at least one pyrazine,pyrimidine, pyridazine or derivatives thereof. In other embodiments, theprodrug composition(s) may contain or utilize a heteroaryl group thatcomprises three heteroatoms. In additional embodiments, the prodrugcomposition(s) may contain or utilize a heteroaryl carboxylic acid thatis at least one 1,2,3-triazine, 1,2,4-triazine, 1,3,5-triazine orderivatives thereof. In other embodiments, the prodrug composition(s)may contain or utilize the at least one aryl carboxylic acid comprises asix-membered ring. Moreover, the prodrug composition(s) may contain orutilize a six-membered ring that comprises additional substituted orunsubstituted aromatic or aliphatic rings. In other embodiments, theprodrug composition(s) may contain or utilize at least one arylcarboxylic acid that comprises only one free carboxylic acid group. Infurther embodiments, the prodrug composition(s) may contain or utilizeat least one aryl carboxylic acid that comprises, for example, between 1to 4 substituents on the aryl ring.

In other embodiments, the prodrug composition(s) of the presenttechnology may be in the form of a conjugate that is a neutral prodrug.In other embodiments, the prodrug composition(s) of the presenttechnology may be in the form of a conjugate that is a free acid. Instill other embodiments, the prodrug composition(s) of the presenttechnology may be in the form of a conjugate that is a free base. Inother embodiments, the prodrug composition(s) of the present technologymay be in the form of a conjugate that is a pharmaceutically acceptableanionic or cationic salt form or salt mixtures thereof. In someembodiments, the prodrug composition(s) of the present technology may bein the form of a salt that is selected from the group consisting of, forexample, acetate, l-aspartate, besylate, bicarbonate, carbonate,d-camsylate, l-camsylate, citrate, edisylate, formate, fumarate,gluconate, hydrobromide/bromide, hydrochloride/chloride, d-lactate,l-lactate, d,l-lactate, d,l-malate, l-malate, d-malate, mesylate,pamoate, phosphate, succinate, sulfate, bisulfate, d-tartrate,l-tartrate, d,l-tartrate, meso-tartrate, benzoate, gluceptate,d-glucuronate, hybenzate, isethionate, malonate, methylsufate,2-napsylate, nicotinate, nitrate, orotate, stearate, tosylate,thiocyanate, acefyllinate, aceturate, aminosalicylate, ascorbate,borate, butyrate, camphorate, camphocarbonate, decanoate, hexanoate,cholate, cypionate, dichloroacetate, edentate, ethyl sulfate, furate,fusidate, galactarate (mucate), galacturonate, gallate, gentisate,glutamate, glutarate, glycerophosphate, heptanoate (enanthate),hydroxybenzoate, hippurate, phenylpropionate, iodide, xinafoate,lactobionate, laurate, maleate, mandelate, methanesufonate, myristate,napadisilate, oleate, oxalate, palmitate, picrate, pivalate, propionate,pyrophosphate, salicylate, salicylsulfate, sulfosalicylate, tannate,terephthalate, thiosalicylate, tribrophenate, valerate, valproate,adipate, 4-acetamidobenzoate, camsylate, octanoate, estolate, esylate,glycolate, thiocyanate, undecylenate, sodium, potassium, calcium,magnesium, zinc, aluminium, lithium, cholinate, lysinium, ammonium andtromethamine, mixtures thereof, and derivatives thereof.

In certain embodiments of the present technology, the prodrugcomposition(s) of the may be broken down in vivo releasing activehydromorphone, the aryl carboxylic acid, derivatives thereof andmetabolites thereof. In other embodiments, the prodrug composition(s) ofthe present technology may be in the form of a prodrug that isadministered orally and is hydrolyzed in vivo releasing hydromorphonefrom the prodrug. In additional embodiments, the prodrug composition(s)of the present technology may be in the form of a prodrug that exhibitsno or limited pharmacological activity upon administration. In otherembodiments, the prodrug composition(s) of the present technology may bein the form of a prodrug that releases hydromorphone in a manner that issimilar to free or unmodified hydromorphone upon administration atequimolar dosages. In further embodiments, the prodrug composition(s) ofthe present technology may release hydromorphone into the systemiccirculation in a decreased/controlled manner when the prodrug isadministered via routes other than oral. In other embodiments, theprodrug composition(s) of the present technology may be in the form of aprodrug that releases hydromorphone in a controlled or sustained mannerupon administration.

In certain embodiments of the present technology, the prodrugcomposition(s) of may be in the form of a prodrug that has no ordecreased side effects compared to unmodified hydromorphone uponadministration at equimolar dosages. In other embodiments, the prodrugcomposition(s) may be in the form of a prodrug that exhibits no ordecreased side effects selected from, for example, dizziness,lightheadedness, drowsiness, nausea, vomiting, constipation, stomachpain, rash, difficulty urinating, difficulty breathing, neuroexcitatoryeffects or fainting.

In other embodiments of the present technology, the prodrugcomposition(s) do not result in high hydromorphone concentrations in theplasma or blood compared to unmodified hydromorphone upon administrationat equimolar dosages by intravenous or intranasal routes. In furtherembodiments, the prodrug composition(s) do not cause or reduce euphoriaor drug liking effects upon intranasal administration. In otherembodiments, the prodrug composition(s) do not cause or reduces euphoriaor drug liking effects upon intravenous administration. In alternativeembodiments, the prodrug composition(s) do not result in a rapidhydromorphone concentration spike (C_(max)) in the blood or plasma uponoral administration. In additional embodiments, the prodrugcomposition(s) exhibit a delayed T_(max) compared to unmodifiedhydromorphone when administered orally at equimolar dosages. In otherembodiments, the prodrug composition(s) exhibit a lower C_(max) valuecompared to unmodified hydromorphone when administered orally atequimolar dosages. In additional embodiments, the prodrug composition(s)exhibit increased relative bioavailability of hydromorphone compared tounmodified hydromorphone when administered orally at equimolar dosages.In further embodiments, the prodrug composition(s) exhibit a higherC_(max) value compared to unmodified hydromorphone when administeredorally at equimolar dosages. In alternative embodiments, the prodrugcomposition(s) a higher AUC value compared to unmodified hydromorphonewhen administered orally at equimolar dosages. In additionalembodiments, the prodrug composition(s) exhibit higher C_(max) and AUCvalues compared to unmodified hydromorphone when administered orally atequimolar dosages.

In other embodiments of the present technology, the prodrugcomposition(s) do not liberate hydromorphone when the composition isphysically manipulated. In additional embodiments, the prodrugcomposition(s) exhibit resistance to certain chemical manipulationsintended to liberate free hydromorphone.

In additional embodiments of the present technology, the prodrugcomposition(s) exhibit no or insignificant activity at μ-opioidreceptors. In other embodiments, the prodrug composition(s) are not orlimitedly subjected to enzymatic hydrolysis until it is absorbed in thegut. In additional embodiments, the prodrug composition(s) exhibitdecreased conversion to hydromorphone-3-glucuronide (H3G) compared tounmodified hydromorphone when administered orally at equimolar dosages.

In other embodiments of the present technology, the prodrugcomposition(s) prevent or decrease opioid induced constipation (OIC)compared to unmodified hydromorphone when administered orally atequimolar dosages.

In certain embodiments of the present technology, the prodrugcomposition(s) additionally comprise, for example, ibuprofen,acetaminophen, or aspirin. In some embodiments of the presenttechnology, the prodrug composition(s) contain or utilize a conjugatethat is selected from the group consisting of, for example,3-aspirin-hydromorphone, 3,6-di-aspirin-hydromorphone,6-o-salicylate-hydromorphone, 3-cinnamate-hydromorphone,6-naproxen-hydromorphone, 3-isoniacin-hydromorphone,3-p-salicylic-hydromorphone, 3-fenamate-hydromorphone,3-benzoate-hydromorphone, and 3,6-di-benzoate-hydromorphone.

In other embodiments of the present technology, the prodrugcomposition(s) are in an oral dosage form. In additional embodiments,the prodrug composition(s) are in an oral dosage form that is selectedfrom the group consisting of, for example, tablet, capsule, caplet,troche, lozenge, powder, suspension, syrup, solution, softgel capsule,slurry, sublingual drops and oral thin film (OTF). In certainembodiments, the prodrug composition(s) are an oral dosage form that isa solid dosage form. In other embodiments, the prodrug composition(s)are in a solid dosage form and also contain at least one excipient. Infurther embodiments, the prodrug composition(s) contain an excipientthat is selected from the group consisting of, for example,antiadherents, binders, coatings, disintegrants, fillers, flavors,colors, glidants, lubricants, preservatives, sorbents and sweeteners. Inadditional embodiments, the prodrug composition(s) are formulated intotablets, capsules, modified release capsules, softgel capsules, extendedrelease tablets, controlled release capsules, suppositories, powders forinjection, oral liquids, cough syrups, transdermal film, slurry orinjections.

In other embodiments of the present technology, the prodrugcomposition(s) are in an oral dosage strength that is equimolar to fromabout 0.1 mg to about 200 mg of unmodified hydromorphone. In additionalembodiments, the prodrug composition(s) are in an oral dosage strengththat is equimolar to from about 1 mg to about 200 mg of unmodifiedhydromorphone. In other embodiments, the prodrug composition(s) are inan oral dosage strength that is equimolar to from about 2 mg to about 8mg of unmodified hydromorphone. In further embodiments, the prodrugcomposition(s) are in an oral dosage strength that is equimolar to fromabout 8 mg to about 60 mg of unmodified hydromorphone. In additionalembodiments, the prodrug composition(s) are in an oral dosage strengththat is equimolar to from about 60 mg to about 200 mg of unmodifiedhydromorphone.

Other embodiments of the present technology are directed to methods oftreating a patient in need of an analgesic effect by administering aneffective amount of any of the prodrug composition(s) of the presenttechnology. Additional embodiments of the present technology aredirected to treating a patient in need of a cough suppressant byadministering an effective amount of any of the prodrug composition(s)of the present technology. In additional embodiments, the presenttechnology is directed to a method of treating a patient in need oftherapy for narcotic or drug addiction by administering an effectiveamount of any of the prodrug composition(s) of the present technology.In certain methods of treatment of the present technology the prodrugcomposition(s) are in an oral dosage form. In other methods of treatmentof the present technology the prodrug composition(s) are in an oraldosage form that is selected from, for example, a tablet, capsule,caplet, troche, lozenge, powder, suspension, syrup, solution, softgelcapsule, slurry, sublingual drops and oral thin film (OTF). Inadditional methods of treatment of the present technology the prodrugcomposition(s) are in a solid dosage form. In other embodiments, themethods of treatment of the present technology comprise prodrugcomposition(s) in a solid dosage form that further comprises anexcipient. In additional embodiments, the methods of treatment of thepresent technology comprise prodrug composition(s) in a solid dosageform that further comprises an excipient that is selected from the groupconsisting of, for example, antiadherents, binders, coatings,disintegrants, fillers, flavors, colors, glidants, lubricants,preservatives, sorbents and sweeteners.

In other embodiments, the methods of the present technology utilizeprodrug composition(s) that are formulated into, for example, tablets,capsules, modified release capsules, softgel capsules, extended releasetablets, controlled release capsules, suppositories, powders forinjection, oral liquids, cough syrups, transdermal film, slurry orinjections. In other embodiments, the methods of the present technologyutilize prodrug composition(s) wherein the oral dosage strength isequimolar to from about 0.1 mg to about 200 mg of unmodifiedhydromorphone. In additional embodiments, the methods of the presenttechnology utilize prodrug composition(s) wherein the oral dosagestrength is equimolar to from about 2 mg to about 8 mg of unmodifiedhydromorphone. In further embodiments, the methods of the presenttechnology utilize prodrug composition(s) wherein the oral dosagestrength is equimolar to from about 8 mg to about 60 mg of unmodifiedhydromorphone. In other embodiments, the methods of the presenttechnology utilize prodrug composition(s) wherein the oral dosagestrength is equimolar to from about 60 mg to about 200 mg of unmodifiedhydromorphone.

Additional embodiments of the present technology are directed to methodsof synthesizing any of the prodrug composition(s) of the presenttechnology wherein the synthesis comprises the steps of chemicallybonding at least one aryl carboxylic acid to at least one hydromorphone.In other embodiments, the methods of synthesizing any of the prodrugcomposition(s) of the present technology are directed to the synthesisof, for example, 3-aspirin-hydromorphone, 3,6-di-aspirin-hydromorphone,6-salicylate-hydromorphone, 3-cinnamate-hydromorphone and3-benzoate-hydromorphone.

Other embodiments of the present technology are directed to apharmaceutical kit comprising a specified amount of individual doses ofthe prodrug composition(s) of the present technology in a packagecontaining a pharmaceutically effective amount of at least one conjugatewherein the conjugate comprises at least one hydromorphone and at leastone aryl carboxylic acid. In further embodiments, the kits of thepresent technology include a method of treating or preventing pain in ahuman or animal patient. In additional embodiments, the kits of thepresent technology are for treating a pediatric patient, an elderlypatient and/or a normative patient. In further embodiments, the kits ofthe present technology include individual dosages of the prodrugcomposition(s) of the present technology comprising at least about 0.1mg or higher of at least one conjugate of the present technology. Inother embodiments, the kits of the present technology include individualdosages of the prodrug composition(s) of the present technologycomprising at least about 1 mg, about 2.5 mg, about 5.0 mg, about 10 mg,about 20 mg, about 50 mg, about 100 mg, about 200 mg, about 500 mg, orhigher of at least one conjugate of the present technology. Inadditional embodiments, the kits of the present technology include fromabout 1 to about 90, about 1 to about 60, or about 10 to about 30individual doses of at least one prodrug composition(s) of the currenttechnology.

The presently described technology is now described in such full, clear,concise, and exact terms as to enable any person skilled in the art towhich it pertains, to practice the same. It is to be understood that theforegoing describes preferred embodiments of the technology and thatmodifications may be made therein without departing from the spirit orscope of the invention as set forth in the appended claims.

The invention claimed is:
 1. A compound-having the following structure:


2. A composition comprising a conjugate having the structure of claim 1,a pharmaceutically acceptable salt thereof, or a combination thereof. 3.The composition of claim 2, wherein the at least one conjugate and/or atleast one pharmaceutically acceptable salt thereof is used to treatnarcotic or opioid abuse; to prevent narcotic or opioid withdrawal; totreat moderate to severe pain; to reduce or prevent oral, intranasal orintravenous drug abuse; or to provide oral, intranasal, or parenteraldrug abuse resistance.
 4. The composition of claim 3, wherein oraladministration of the at least one conjugate and/or at least onepharmaceutically acceptable salt thereof results in an improved rate ofrelease over time when compared to unconjugated hydromorphone over thesame time period.
 5. The composition of claim 3, wherein oraladministration of the at least one conjugate and/or at least onepharmaceutically acceptable salt thereof results in less variability inthe oral PK profile when compared to unconjugated hydromorphone.
 6. Thecomposition of 3, wherein oral administration of the at least oneconjugate and/or at least one pharmaceutically acceptable salt thereofresults in reduced side effects when compared with unconjugatedhydromorphone.
 7. The composition of claim 6, wherein the reduced sideeffect is reduced opioid induced constipation.
 8. The composition ofclaim 2, wherein the at least one conjugate and/or at least onepharmaceutically acceptable salt thereof is provided in a dosage formselected from the group consisting of a tablet, a capsule, a caplet, asuppository, a troche, a lozenge, an oral powder, a solution, an oralfilm, a thin strip, a slurry, a suspension, a gel, an oral strip, arectal film, a transdermal patch, a syrup, and an inhalation compound.9. The composition of claim 3, wherein oral administration of the atleast one conjugate and/or at least one pharmaceutically acceptable saltthereof provides a therapeutically bioequivalent AUC and/or abioequivalent when compared to an equivalent molar amount ofunconjugated hydromorphone.
 10. The composition of claim 3, whereinintranasal or intravenous administration of the at least one conjugateand/or at least one pharmaceutically acceptable salt thereof provides alower AUC and/or C_(max) when compared to an equivalent molar amount ofunconjugated hydromorphone.
 11. The composition of claim 3, wherein oraladministration of the at least one conjugate and/or at least onepharmaceutically acceptable salt thereof provides a decreased overdosepotential when compared to an equivalent molar amount of unconjugatedhydromorphone.
 12. The composition of claim 2, wherein the at least oneconjugate and/or at least one pharmaceutically acceptable salt thereofprovides an increased tamper resistance when compared to unconjugatedhydromorphone.
 13. The composition of claim 2, wherein the conjugateand/or pharmaceutically acceptable salt thereof is a prodrug.
 14. Thecomposition of claim 2, wherein the pharmaceutically acceptable salt ofthe conjugate is an anionic salt form, amphoteric salt form,zwitterionic salt form or cationic salt form, or salt form mixturesthereof.
 15. The composition of claim 14, wherein the anionic salt formis selected from the group consisting of acetate, l-aspartate, besylate,bicarbonate, carbonate, d-camsylate, l-camsylate, citrate, edisylate,formate, fumarate, gluconate, hydrobromide/bromide,hydrochloride/chloride, d-lactate, l-lactate, d,l-lactate, d,l-malate,l-malate, mesylate, pamoate, phosphate, succinate, sulfate, bisulfate,d-tartrate, l-tartrate, d,l-tartrate, meso-tartrate, benzoate,gluceptate, d-glucuronate, hybenzate, isethionate, malonate,methylsulfate, 2-napsylate, nicotinate, nitrate, orotate, stearate,tosylate, thiocyanate, acefyllinate, aceturate, aminosalicylate,ascorbate, borate, butyrate, camphorate, camphocarbonate, decanoate,hexanoate, cholate, cypionate, dichloroacetate, edentate, ethyl sulfate,furate, fusidate, galactarate, galacturonate, gallate, gentisate,glutamate, glutarate, glycerophosphate, heptanoate, hydroxybenzoate,hippurate, phenylpropionate, iodide, xinafoate, lactobionate, laurate,maleate, mandelate, methanesulfonate, myristate, napadisilate, oleate,oxalate, palmitate, picrate, pivalate, propionate, pyrophosphate,salicylate, salicylsulfate, sulfosalicylate, tannate, terephthalate,thiosalicylate, tribrophenate, valerate, valproate, adipate,4-acetamidobenzoate, camsylate, octanoate, estolate, esylate, glycolate,thiocyanate, and undecylenate.
 16. The composition of claim 14, whereinthe cationic salt form is selected from the group consisting of sodium,potassium, calcium, magnesium, zinc, aluminum, lithium, cholinate,lysinium, ammonium and tromethamine.